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NPI Code Detail

MEDICARE: DR. NANCY RUSSO LMHC

MEDICARE:  DR. NANCY  RUSSO  LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorMH6919FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881691087
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NANCY RUSSO LMHC
Provider Business Mailing Address
First Line : 330 KAY LARKIN DR
Second Line :
City : PALATKA
State : FL
Zip : 32177-2307
Country : US
Telephone Number : 386-385-1243
Fax Number :
Provider Business Practice Location Address
First Line : 330 KAY LARKIN DR
Second Line :
City : PALATKA
State : FL
Zip : 32177-2307
Country : US
Telephone Number : 386-385-1243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 02/18/2025

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Directions to “ DR. NANCY RUSSO LMHC” Practice Location

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